Public health specialist workforce training.

Abstract

Uk PUblic HealtH SPecialiSt Workforce trainingthe adage that 'public health is everybody's business' can both be a help and a hindrance in developing the public health workforce. as everybody's business, teaching and development can be tucked into other people's business, for example, in medical student curricula or primary care. In the uK, the General Medical Council (GMC),1 the professional medical regulation authority, recommends that all medical students should be able to 'apply to medical practice the principles, method and knowledge of population health and the improvement of health and healthcare', going on to list 11 relevant areas of study. While this provides wide exposure, it does not, however, take away from the need for depth in specialist knowledge. across the world, attitudes to the importance of public health in medical training vary, as does support for its inclusion in the curriculum. It is common, however, among teachers for medical students to prefer the cut and thrust of genomic advances and individual patient care, seen to have more prestige and glamour, to that of the more complex problems of improving population health and reducing health inequalities. this prejudice is reinforced across medical systems, for instance, in research funding. But why does this matter? In the uK, the traditional route to specialist practice is through an adapted medical education model of specialist training, that is, that those wanting to practice public health as specialists first have general undergraduate training before specializing. this specialist public health model is adapted to be multidisciplinary - and specialists come from a wide variety of backgrounds to enter a common scheme of training which provides structured competency-based training over a period of years. While equivalent Specialist status is granted by the Faculty of Public Health (FPH),2 the public health arm of the professional system based on royal colleges, registration remains divided between those who are and who are not medically qualified - a source of continuing debate.tHe PUblic HealtH Workforce in aSiaSuch debate does not apply to the uS style-based training in which Schools of Public Health play a key role, and the association of Schools of Public Health3 set curriculum standards and define practice, with the Masters of Public Health playing a more prominent role.In asia, the systems are mixed and becoming more so. asia faces massive social, demographic and economic changes as countries transition to more affluent and urbanised societies. Infectious disease is no longer the primary burden as problems associated with increasing obesity rates, tobacco smoking and loneliness in old age continue to grow. Poorer communities in asia are those most likely to be affected by climate change, and pollution and environmental sustainability pose urgent population health challenges.to be fit for purpose, the public health workforce needs to be appropriately trained and supported. But are the models of training, particularly of specialists, appropriate? Workforce shortages, especially in rural areas, call for new ways of thinking and working.the uK model of clinically based training has left its legacy in asia, but former colonies have not necessarily moved away from the clinical model and followed the same trajectory of multidisciplinary change. For instance, in Hong Kong, the HK College of Community Medicine, the FPH equivalent, does not follow the FPH lead and bestow specialist status on fellows who are not doctors. at the same time, the universities have not only expanded their Masters in Public Health programmes but introduced Bachelors programmes and extended the option of general education courses.4So who is a specialist - the College fellows or the university trained Masters/ PhD students? and why is this important? the rationale for expanding the range of training in Hong Kong was based on the increasingly obvious analysis that not only were health needs growing but that health services needed to become more public health aware and focus on prevention rather than provision of care. …